Referring physicians prefer to talk to radiologists rather than use decision-support software when deciding what imaging exams are appropriate for their patients, according to a presentation delivered at the American College of Radiology annual meeting (ACR 2016) in Washington, DC.
While clinical decision-support algorithms and software may be beneficial, personal consultation between the radiologist and clinician adds value to exam interpretation and to team discussion, said presenter Dr. Kalpana Suresh of Christiana Care Health System in Newark, DE.
Dr. Kalpana Suresh of Christiana Care Health System."As the shift from fee-for-service to value-based payments continues, in-house radiologists are in an ideal position to serve as gatekeepers for ordered imaging studies," Suresh said. "At our institution, we are trying to proactively engage clinicians in a physician-to-physician discussion about their patient and the best way to answer their clinical question."
Chasing consensus
Suresh and colleagues examined 1,778 orders for CT, MR, and PET scans placed by referring physicians between July 2014 and May 2015 that were reviewed by in-house radiologists. Each of the orders was categorized as "approved," "rejected," or "alternative suggested." For those exams that were deemed inappropriate or for which an alternative was recommended, the radiologist contacted the referring physician and worked to reach a consensus on the order.
The group found that 86% of the studies ordered were approved. For the 169 cases placed in the "alternative suggested" category, the radiologist recommended a more appropriate exam, and 90% of these suggestions were accepted by the ordering physician.
For the 72 orders marked "rejected" -- indicating an inappropriate or unnecessary exam -- the ordering clinician agreed with this assessment in 72% of the cases. In 28%, the ordering physician insisted that the study be performed anyway.
For the most part, pathology proved radiologists correct in their assessments of the ordered exams: Among 37 studies that had been designated inappropriate or for which an alternative exam had been recommended, only five showed relevant pathology that confirmed the use of the initially ordered exam.
Commitment required
Using in-house radiologists as quality control for advanced imaging exams is feasible. But it does require some commitment, Suresh said.
"Our process involved a significant amount of manual input and time, as our radiologists had to review prior imaging and the patients' medical records for each case," she said. "To initiate this on a larger scale, many processes would need to be automated."
So what's the takeaway? Referring physicians prefer contact with radiologists when they're ordering imaging tests for their patients, according to Suresh.
"In an independent survey we sent out after we conducted this research, physicians preferred consulting with a radiologist over a radiology benefits manager or decision-support software -- in fact, a majority of clinicians agreed that this method was actually more efficient than the existing system," she concluded. "Our study results show that radiologists serving directly as 'consultant gatekeepers' have the potential not only to eliminate unnecessary testing, but also to improve interdisciplinary communication."
